Member Services Director jobs in Texas

POSITION SUMMARY/RESPONSIBILITIES
Directs and focuson the Special Health Care Needs (SHCN) population STAR Kids and STAR Plus within Community First member services’ departments in an effective manner to includes all lines of business related to Member Service Resolution Unit Governs and assumes accountability for the execution and monitoring services and support of the enrollment, resolution, quality monitoring/training and phone center units including inventory of resource materials for staff, and of policies and job aids related to SHCN .Supporting the other Assistant Director , Member Services as needed. Responsible and accountable for ensuring that staff are knowledgeable in conjunction with collaborating with all necessary Member service units and other departments prioritizing STAR Kids and STAR PLUS to ensure info is current ensuring that all regulatory and/or contractually requirements are met. In addition to conducting analysis/deliverable reports. Ensuring adherence to all SHCN plans contractual/regulatory requirements and subsequent contract updates/changes are implemented accordingly. Ensures process improvement by monitoring/trending key metrics for the department, proactively identifies issues and improvement opportunities, and conducts frequent updates to department and health plan leadership as appropriate. Complies with and enforces organizational and departmental policies and procedures. Actively uses and understands Community First’s Member Service systems that interface with the core operating system. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regard to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE
Bachelor’s degree in Business, Health Care Administration or related field is required. Minimum of five years’ experience with special health care needs population, in insurance, medical or managed care environment required. Requires prior leadership experience managing enrollment, call center, or other related managed care departments in the health insurance industry for STAR Kids, STAR PLUS , commercial, Medicaid, and Medicare programs. Experience with QNXT call center module systems and phone system is strongly preferred.